Here's What Happened When I Tried Moderation Management

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Here’s What Happened When I Tried Moderation Management

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This post was originally published on July 18, 2014.

Every now and then my addiction tries to convince me that I never truly hit bottom with alcohol and could probably drink moderately again one day. When that happens, I remind my disease that I’ve tried that, thanks. Before surrendering to 12-step recovery, I tried Moderation Management, a secular support group for “non-dependent problem drinkers.”

I had good reason to be worried about my drinking, since I’d kicked a coke habit less than two years prior. Back then, I’d made a conscious decision not to quit drinking because—say it with me, kids—alcohol wasn’t my problem! I craved the sharp bright grip of stimulants, and anything that made me feel slower and dumber wasn’t something I was going to lose control over. Right? Plus, drinking was so much harder to avoid. Even my friends who were “good kids” drank, and if I couldn’t, I’d surely feel deprived of all fun—and be more likely to throw in the towel on the whole getting better thing and make a beeline for the nearest coke supplier. I actually thought I was finding a balance for a change.

As I soon discovered, though, alcohol is a drug. Period. I didn’t want to catch alcoholism, but before long it got harder to escape the sense that it might be catching me. One day while nursing the umpteenth marathon hangover, I made a few Google searches and found MM’s woefully ‘90s website. Bingo! Bye bye, emergency Gatorade cache in the car—now I would learn how to control my drinking and be a normal person at last.

Our meeting consisted of seven people in a therapist’s office. Each week we went around and shared how we were moderating and managing and set drinking goals for the following week. We shared techniques like “pacing and spacing,” which is easier said than done. AA-bashing was considered bad form , but there was no talk of disease or spirituality in this heavily CBT-influenced program. Cross-talk was encouraged, and I felt supported by the other, older people in my group.

MM does outline nine “steps” towards change, but they’re more like guidelines and can be done in any order. We rarely talked about the steps at all. All I remember was that Step 2 involved 30 days without drinking. We called it “doing a 30,” and I just never did it, though others did. My longest dry run was 10 days, and since there are no sponsors, nobody made me do more. I did buy the textbook called Responsible Drinking, where I identified my drinking triggers and life goals and set personalized drinking rules. I even filled out the big questionnaire to help determine whether abstinence would be a better path (aka, whether I was a bona fide alkie). I scored right on the borderline, because let’s face it, the line between “sometimes” and “often” can be pretty damn blurry.

I was lucky to have a meeting in my area. They’re few and far between, so MM relies heavily on an online community—aka an email listserv. Having associated listervs with the dark ages, I was completely unprepared for this aspect of the program. Each day, literally a hundred new messages from problem drinkers all over the globe flooded my inbox. It was impossible to read them all, and I found myself latching on to certain members and threads and guiltily scrolling past others. One longtime MMer posted daily CBT exercises. Another led the “Ice Cream Thursdays” thread each week, where anybody planning to “abs” for the day would announce the flavor of frozen dessert they were going to eat instead of drinking. There was a whole lingo to learn: abstaining three days in a row was a “trike,” four made you “f’abs.” We usually committed to these dry runs in groups (as in, “Who’s up for a trike this week?”) and would check in daily to report our success.

Then there was the notorious “train.” At the start of each month, anyone who wanted to ride it would choose a certain number of drinks as their daily maximum. Ideally, we’d scale back our max each month until it stayed firmly in the green zone: four drinks for men, three for women. I could never manage a limit below five. The most annoying part of this wasn’t counting the physical drinks, it was figuring out how many drinks my drinks counted as. Some cocktails, and even some beers, contained enough alcohol for two or even three standard drinks. All in all, it was a lot more math than I’d bargained for.

But there was one more requirement to ride the train: you couldn’t drink more than two days in a row. So if you wanted to party (moderately) on Friday and Saturday, both Thursday and Sunday were off limits. I struggled with the two-day rule even more than with the daily max. It completely changed my conception of what a weekend was. The power of the train resided in accountability. Each rider had to log their daily drink count in a public forum. Breaking either the daily max or the two-day rule constituted “falling off the train,” but those who did so were still encouraged to pick themselves up and “run alongside it” rather than downing the nearest fifth of bourbon and calling it a month.

For five months, I went to meetings almost weekly, rode the train and logged my drinks and dry days. But one night, despite feeling connected to both the in-person and online groups, I just stopped going. I assumed I would go back the next week, and I didn’t. Then I stopped checking my listserv. My last public log in consists mainly of red numbers (too many drinks) and big swaths of green zeroes (for dry days). All or nothing. The language of alcoholism. By the end of the month I’d stopped logging drinks altogether, and soon I was a permanent resident of Hangoverland once more.

Lest I give the impression that MM was completely useless, it wasn’t. It did help me scale back my drinking for a while, and if stopping early ever saved me from a DUI, I’ll never know for sure (though it didn’t help the program’s founder, Audrey Kishline). But mostly it just threw my very real drinking problem into stark relief. There were some in MM who clearly didn’t need AA.  Just as I was writing this I opened up my listserv account and saw many of the same names, still triking and training along. Good for them. For me, abstinence ultimately ended up being not only necessary but easier, though I never could have imagined it back then. There were others in the meetings who were just like me. I wonder if they still go, or if they’ve surrendered to sobriety too. Though I feel a twinge of sadness at the thought that I’ll never go back there to find out, I know I’ve found where I belong.

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13 Comments

  1. This post can be summed up very easily, and the source of your failure is clear: “All I remember was that Step 2 involved 30 days without drinking. We called it “doing a 30,” and I just never did it, though others did. My longest dry run was 10 days, and since there are no sponsors, nobody made me do more.”

    – You clearly are not a candidate for moderation management. You have a serious alcohol addiction if you cannot go 30 days without drinking alcohol. You skipping this vital, foundational introductory step is like buying a table, pulling out the table top as step 1, screwing only 2 of the legs in as part of step 2 rather screwing all 4 legs…and then concluding after the table fails to stand, “Yup…this table is no good.”

  2. Pingback: 3 Ways Sobriety is Nothing Like I Expected it to Be  

  3. Pingback: Moderation’s hard work for an alcoholic! | Addiction & Recovery News

  4. For Erica, Moderation Management succeeded brilliantly! How so, you ask? Because one of the basic ideas behind MM is that the individual drinker needs to make his or her own decision about how to address problems arising from drinking. MM supports abstinence (Erica’s long strings of Green days on the online self-monitoring page are not atypical!), and in fact recommends that a period of abstinence precede any attempt at moderation. MM also supports taking a cold, hard look at drinking, and at acknowledging to oneself when moderation (inherently more difficult than abstinence which requires, at bottom, one single skill implemented over and over: saying, “No, thanks!”) is not working. That Erica was able to come to a conclusion about her drinking and moderation efforts that worked for her is exactly what MM is about. In my book with Marc Kern and Rudy Hoeltzel (himself a long time MM member and leader) “Responsible Drinking” A MODERATION MANAGEMENT Approach for Problem Drinkers”, we make this perfectly clear. So, my main point here is to say “congratulations”, both to Erica for finding her way, and to MM for providing her with some of the experiential and systematic evidence that helped her do that!

    • Yes, there is a place for MM in self help for substance use disorders. But people who are alcohol dependent cannot moderate … for long. And they will rationalize to themselves, as Erica shows here, that they can drink moderately again—sometimes with tragic consequences. Her story also shows that loss of control with one drug (cocaine in her case) points to the likelihood that even support from MM may not be enough to allow “moderate” drinking. The key will be the person’s willingness to see and accept their inability to stop using drugs or alcohol despite negative consequences.

      • Chuck, you missed the point of my post entirely! What MM does is to facilitate the kind of self-examination and decision-making about one’s drinking that the vast majority of problem drinkers do on their own, without outside help. The primary goal of MM is this–NOT to impose or suggest moderation to anyone–but to provide a safe place where they can openly discuss their feelings and thoughts about how they want to live their lives, without fear that the abstinence Mafia will belittle or denigrate them because they are even entertaining the idea of moderation!

        • Sorry, I don’t think i missed your point. What I’m saying is that there are some individuals who already are already not able to keep to moderation when they try MM; or who are in MM for awhile and discover they can no longer moderate (like Audrey Kishline) and then continue to hide that fact while they drink secretly. That person would be alcohol dependent. If they are dishonest about their drinking with others in MM, as they could also be in AA, the consequences can be disastrous. Honesty about drinking is crucial part of success, whether that person is active in AA or MM.

          MM used to make reference to that person as an “alcoholic,” I believe, and even said that MM would not be for them.

          In Eric’s story, she was eventually honest, and even thankful that negative consequences as severe as a DUI (or something worse) did not happen to her as she was deciding whether or not she should continue to try and moderate her drinking.

          The second point I was making is that loss of control/dependency with another drug (cocaine, heroin, etc.) is an indication of the potential difficulty of the individual being able to maintain moderate use of alcohol. I’ve seen this particularly with individuals who had a dependency problem with “downer” drugs like alcohol: heroin, benzos, etc. They risk eventually having the loss of control with alcohol that they experienced with their other drug(s).

          The MM process is cognitive and behaviorally based and does say that to moderate or not is up to the individual. For individuals who already have, or who develop a physical dependency/inability to control (moderate) their intake of alcohol, continuing to try and moderate their drinking can lead to a disaster.

          In addition, even moderate drinking could lead to the person to deciding to use the drug they already see themselves as not able to control. Remember the 1950s/1960s films of how alcohol effects decision making and judgement in those old driver’s education videos.

          • You are still missing the point. The point is that we cannot effectively tell people that they can or cannot moderate–that knowledge, to be true and committed to (even though it may not be liked) needs to come from the person. That is what happens, I believe, when people, in 12-step terms, “hit bottom”. The individual makes the realization for themselves, not us or anyone else–only the individual can do this. The fact that we, as external observers, can often see that a particular course of action or goal is likely to result in disappointment or failure does NOT mean that we can create that knowledge in the other person. We (and in MM members frequently do) can share our concerns with the other person, but that is it. The other person will then choose to (or not) incorporate our concerns into the data they are gathering about the viability of a particular goal or plan of action. We cannot invoke, coerce, or otherwise instill honesty (although honesty is important when people examine the data about themselves). The more we try to do so, to tell the person that they are misleading themselves or ignoring parts of the evidence of their lives they don’t like or want to see, the more resistance and push-back we get. Miller & Rollnick showed this many years ago as they studied early forms of motivational interviewing. People must learn for themselves. The old adage, “you can lead a horse to water, but you cannot make her drink” applies wonderfully here. We, as counselors and concerned others, can serve as guides, but we cannot produce the outcome–only the client can!

          • Sounds like what I hear happening at good AA meetings. Yes, there can be some Big Book “bible” thumpers who take a hard line with newcomers about drinking. The element of choice is never absent in whether or not a person drinks. But remember the “old Chinese proverb:” first the man takes a drink, then the drink takes a drink, then the drink takes a man.

            What’s missing in your emphasis is the acknowledgement that for some individuals with substance use disorders, attempts at moderation can be dangerous because of 1) an already existing loss of control/dependency with alcohol or drugs; or 2) a real potential for the individual to progress to loss of control/dependency because of past history of dependency with other substances, family history, etc. There is a neurochemical, genetic component to substance use disorders. I don’t think it’s purely that, but it can play a part with some individuals.

            From the MM website:
            This is your decision. To be successful at moderation or abstinence requires
            effort and a commitment to change. You should take into account the severity
            of your drinking problem, your personal preference, and any medical, psychological,
            or other conditions that would be made worse by drinking, even in moderation.
            If you are unsure, seek professional advice. MM does not provide professional
            assessment or treatment.

            The qualifiers that MM says an individual should take into account are missing from your emphasis on the choice aspect in this forum.

          • You still miss my point. It is not you or me who acknowledges that moderation is not possible for the individual (whether we believe it is or not)–it is the individual who acknowledges and accepts that. What you or I or NIDA or NIAAA think matters not–what matters is what the individual thinks about themselves. The whole notion of a disease is flawed largely because it reifies a behavioral pattern that most people change on their own simply by deciding to do so–hardly characteristic of other diseases many like to view addiction as analogous to–diabetes, hypertension, asthma, etc. No one ever simply decided not to have those diseases and found themselves cured! See Gene Heyman’s wonderful book “Addiction: A Disorder of Choice” for a full discussion of this and the research supporting this idea (research, by the way, that is largely ignored by people who want to believe they KNOW what addiction is!).

          • Respectfully, I don’t think I miss your point. Whether a person drinks or doesn’t drink is a matter of personal choice. But the problem is that for a certain percentage of people (25% if we use the IOM report referenced in your workbook, “Responsible Drinking”) that choice can trigger loss of control with their drinking. From your workbook:

            “In its 1990 report the IOM [Institute of Medicine] found that for every one alcoholic, there are approximately three problem drinkers who are at risk for serious health problems as a result of their drinking, but who do not meet the criteria for the clinical diagnosis of alcoholism, which is called alcohol dependence. . . .

            In plain language, these problem drinkers have some problems related to their control over their drinking, and they may drink often and excessively, and may even take dangerous risks like drinking and driving. But they have not developed the nearly total and consistent loss of control over drinking, and the series of repeated negative consequences related to it that marks alcoholism.”

            So for 25% of the potential individuals with an alcohol use disorder who come to MM, they risk “nearly total and consistent loss of control over drinking, and the series of repeated negative consequences related to it that marks alcoholism” if they attempt to drink moderately.

            In an earlier comment I said: “Yes, there is a place for MM in self help for substance use disorders. But people who are alcohol dependent cannot moderate … for long.” I don’t think MM is for individuals with alcohol dependency. From the Amazon blurb for your workbook: “’Responsible Drinking’ is the only book with research-based techniques that will help non-alcoholic readers overcome their drinking problems.”

            Again, from your workbook: “For alcohol problems, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends that physicians assess patients in brief intervention procedures, and then direct patients to two goals: abstinence if they seem to be alcohol dependent, or alcoholics, and to moderation if they are not alcohol dependent.” For alcoholics, for alcohol dependent individuals, moderation is not an advisable recovery goal.

            The out-of-style DSM-IV language of “alcohol abuse” and “alcohol dependence” captured the differences between problem drinkers and alcoholics very well. And moderation is a legitimate recovery goal for problem drinkers, alcohol abusers. It is not a legitimate recovery goal for people who are alcohol dependent, alcoholics.

            It seems that you reject the possibility of there being a potential neurochemical or biological aspect to substance use disorders. To me, that seems as reductionistic as a pure medical model approach to substance use disorders. The science for neurotransmitter “dysregulation” is very clear and noncontroversial. It doesn’t happen with all drinkers, but will happen with some. Do you want some references?

            The older distinction between abuse and dependence was able to capture the clear pattern of two distinct types of substance use problems. Moderation is a legitimate goal for alcohol abusers, but not for alcoholics; not for alcohol dependency.

          • What?
            You have indeed been missing the point all this time.

            AA never worked for me. Very happy that it works for some.
            In fact, for myself, despite trying different meetings, it depressed the hell out of me. ” ‘God’ can be whatever you want it to be”, …”a Doorknob”..(??) Really?

            What worked for me was, just like Erica, going through a trial of Moderation Management (MM) until I came to the realization that I could not moderate at all after all, and was best off being Abstinent. Good for those who can moderate, and I’m glad I at least gave it a shot. If I had not worked through MM first, I would not have necessarily known or come to the conclusion that I was, in fact, Alcoholic after all; especially given that I had no family history whatsoever nor did I grow up in a drinking culture. I’m certainly not sure if every Alcoholic is necessarily going to know if they are just that, right off the bat.

            You can’t always know to go from 100 to 0 in one giant screech. Sorry.

          • From the Moderation Management website under: “What is Moderation Management?”

            Is MM for every person with a drinking problem?

            No. Research suggests that no one solution is best for all people with drinking
            problems. There are many possible solutions available to each individual,
            and MM suggests the each person finds the solution that is best for him or
            her.

            MM is good place to begin to address a drinking problem. If MM proves to
            be an ineffective solution, the individual is encouraged to progress to a
            more radical solution.

            Is moderation a reasonable option for you?

            This is your decision. To be successful at moderation or abstinence requires
            effort and a commitment to change. You should take into account the severity
            of your drinking problem, your personal preference, and any medical, psychological,
            or other conditions that would be made worse by drinking, even in moderation.
            If you are unsure, seek professional advice. MM does not provide professional
            assessment or treatment.

            Even Moderation Management says it can be a beginning, but if MM is ineffective, try a “more radical solution.” MM also says there are multiple factors to be considered in making a decision on whether or not to choose moderation or abstinence, including “medical, psychological,
            or other conditions that would be made worse by drinking, even in moderation.”

            Again, MM is not for everyone and people who meet the criteria for alcohol dependence should think twice before attempting moderation as a recovery goal.

          • From the Moderation Management website under: “What is Moderation Management?”
            Is MM for every person with a drinking problem?
            No. Research suggests that no one solution is best for all people with drinking problems. There are many possible solutions available to each individual, and MM suggests the each person finds the solution that is best for him or her.

            MM is good place to begin to address a drinking problem. If MM proves to be an ineffective solution, the individual is encouraged to progress to a more radical solution.

            Is moderation a reasonable option for you?
            This is your decision. To be successful at moderation or abstinence requires effort and a commitment to change. You should take into account the severity of your drinking problem, your personal preference, and any medical, psychological, or other conditions that would be made worse by drinking, even in moderation. If you are unsure, seek professional advice. MM does not provide professional assessment or treatment.

            Even Moderation Management says it can be a beginning, but if MM is ineffective, try a “more radical solution.” MM also says there are multiple factors to be considered in making a decision on whether or not to choose moderation or abstinence, including “medical, psychological, 
or other conditions that would be made worse by drinking, even in moderation.”

            Again, MM is not for everyone and people who meet the criteria for alcohol dependence should think twice before attempting moderation as a recovery goal.

      • Jillian Johannson on

        You cannot blanket “all” with your personal view point. Studies show, ETOH dependent people die at the same rate as those who moderate. Including the fact that the total abstinence people die of more painful deaths.

        AA propaganda and AA results are very different. Plus, this country is locked into the propaganda from the drug war, and it is propaganda. Not factual at all.

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Erica Larsen

Erica Larsen blogs at Whitney Calls and CleanBrightDay and is working on one book too many at the moment. She lives in Los Angeles with an enormous cat.

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